Biliary Fistula Clinical Trial
Official title:
Early Versus Late Intervention After Biliary Tract Injury Post Cholecystectomy
Bile duct injury following cholecystectomy is an iatrogenic catastrophe associated with
significant peri operative morbidity and mortality(1, 2) reduced long term survival(3) and
quality of life(4, 5) and high rates of subsequent litigation6. It should be regarded as
preventable.
The advent of laparoscopic cholecystectomy has resulted in a resurgence of interest in bile
duct injury and its subsequent management. Population based studies(6.7) suggest a
significant increase in the incidence of injury (0•1 to 0•5 per cent) following the
implementation of the laparoscopic approach(8) Bile duct injury should be regarded as
preventable, but over 70 per cent of surgeons regard it as unavoidable(9). Although most
injuries occur within the surgeon's first 100 laparoscopic cholecystectomies, one third
happen after the surgeon has performed more than 200; it is more than inexperience that leads
to bile duct injury(10). It has been suggested that the commonest cause of common bile duct
injury is misidentification of biliary anatomy (70-80 per cent of injuries)(11,12),a
reduction in risk if surgeons perform routine intraoperative cholangiography Recognition of
bile duct injury at the time of cholecystectomy allows an opportunity for the hepatobiliary
surgeon to assess its severity and the presence of any vascular injury
Bile duct injury following cholecystectomy is an iatrogenic catastrophe associated with
significant peri operative morbidity and mortality(1, 2) reduced long term survival(3) and
quality of life(4, 5) and high rates of subsequent litigation6. It should be regarded as
preventable.
The advent of laparoscopic cholecystectomy has resulted in a resurgence of interest in bile
duct injury and its subsequent management. Population based studies(6.7) suggest a
significant increase in the incidence of injury (0•1 to 0•5 per cent) following the
implementation of the laparoscopic approach(8) Bile duct injury should be regarded as
preventable, but over 70 per cent of surgeons regard it as unavoidable(9). Although most
injuries occur within the surgeon's first 100 laparoscopic cholecystectomies, one third
happen after the surgeon has performed more than 200; it is more than inexperience that leads
to bile duct injury(10). It has been suggested that the commonest cause of common bile duct
injury is misidentification of biliary anatomy (70-80 per cent of injuries)(11,12),a
reduction in risk if surgeons perform routine intraoperative cholangiography Recognition of
bile duct injury at the time of cholecystectomy allows an opportunity for the hepatobiliary
surgeon to assess its severity and the presence of any vascular injury
;
| Status | Clinical Trial | Phase | |
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| Completed |
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